A Cost-Minimization Analysis Evaluating the Use of Liposomal Bupivacaine in Reconstructive Plastic Surgery Procedures
A Cost-Minimization Analysis Evaluating the Use of Liposomal Bupivacaine in Reconstructive Plastic Surgery Procedures
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DOI：
10.1097/prs.0000000000005435
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发表时间：
2019-04-01
影响因子：
3.6
通讯作者：
Janis, Jeffrey E.
中科院分区：
文献类型：
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作者：
Little, Andrea;Brower, Kristin;Janis, Jeffrey E.
背景：术后疼痛管理对患者满意度和价值至关重要。几项研究评估了布比卡因脂质体在术后疼痛管理方案中的应用；然而，其经济可行性仍未确定。本研究使用国家索赔数据库分析布比卡因脂质体的经济影响，以评估整形和重建手术的术后临床和财务结果。方法：回顾2016年7月1日至2017年7月1日参与医院的整形外科手术（即腹部成形术、腹壁重建、乳房切除术立即放置组织扩张器、乳房切除术直接植入重建、自体乳房重建和隆胸）。主要结局指标为住院时间；7天、14天和30天再入院率；观察到的直接和总成本。结果：研究期间共有958例符合纳入标准。239例（25%）使用布比卡因脂质体。与不使用布比卡因脂质体的病例相比，布比卡因脂质体病例的住院时间缩短（9.2天对5.8天），成本降低（总成本，39,531美元对28,021美元；直接成本，23,960美元对17,561美元），30天再入院率降低（4%对0%）。两组患者的14天和7天再入院率相似。结论：布比卡因脂质体的使用可能有助于减少住院时间、住院费用和腹部和乳房重建手术的30天再入院率，从系统的角度来看，这可能有助于有利的经济概况。随着我们向基于价值的支付过渡，在整个、可定义的、患者流程的背景下，关注价值的衡量和改进将是重要的。
Background: Postsurgical pain management is critical to patient satisfaction and value. Several studies have evaluated liposomal bupivacaine in postoperative pain management protocols; however, its economic feasibility remains undefined. This study analyzes the economic impact of liposomal bupivacaine using a national claims database to assess postoperative clinical and financial outcomes in plastic and reconstructive procedures. Methods: The Vizient Clinical Data Base/Resource Manager electronic database was reviewed for plastic surgery procedures (i.e., abdominoplasty, abdominal wall reconstruction, mastectomy with immediate tissue expander placement, mastectomy with direct-to-implant reconstruction, autologous breast reconstruction, and augmentation mammaplasty) at participating hospitals from July 1, 2016, to July 1, 2017. The main outcome measures were the length of stay; 7-, 14-, and 30-day readmission rates; and direct and total costs observed. Results: During the study period, 958 total cases met inclusion criteria. Liposomal bupivacaine was used in 239 cases (25 percent). Compared with cases that did not use liposomal bupivacaine, liposomal bupivacaine cases had a decreased length of stay (9.2 days versus 5.8 days), decreased cost (total cost, $39,531 versus $28,021; direct cost, $23,960 versus $17,561), and lower 30-day readmission rates (4 percent versus 0 percent). The 14- and 7-day readmission rates were similar between the two groups. Conclusions: The use of liposomal bupivacaine may contribute to a reduction in length of stay, hospital costs, and 30-day readmission rates for abdominal and breast reconstructive procedures, which could contribute to a favorable economic profile from a system view. Focusing on the measurement and improvement of value in the context of whole, definable, patient processes will be important as we transition to value-based payments.